Provider Demographics
NPI:1235371436
Name:LAZZARO, BELINDA (RD)
Entity Type:Individual
Prefix:
First Name:BELINDA
Middle Name:
Last Name:LAZZARO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 SOUTH ST
Mailing Address - Street 2:STE 103
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-3555
Mailing Address - Country:US
Mailing Address - Phone:781-736-0001
Mailing Address - Fax:781-736-0111
Practice Address - Street 1:740 MAIN ST
Practice Address - Street 2:SUITE 112
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451
Practice Address - Country:US
Practice Address - Phone:781-736-0001
Practice Address - Fax:781-736-0111
Is Sole Proprietor?:No
Enumeration Date:2009-04-02
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3117133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA002550301Medicare UPIN